Risk Factors

By Paul J. Ashton, Psy.D., D.Min. 

Consultant to the VIRTUS® Programs

And this is my prayer: that your love may increase ever more and more in knowledge and every kind of perception. 

—Philippians 1:9

This article in the Vulnerable Adults Series will address the risk factors, indicators, types, and signs of abuse that every person who is disabled faces. While the lists are not exhaustive, they present a place to begin when looking for signs of abuse in those who are in vulnerable situations.

These listings are not for the faint of heart. They are serious and unfortunately all too common indicators of abuse which come directly from guidelines from our legal system which seeks to protect all vulnerable persons. No one wants to suspect that abuse can happen to a vulnerable adult—but it does. Please do everything within your power to protect all vulnerable persons. Report your concerns immediately to the proper authorities so that the abuse can be investigated and stopped.

“A vulnerable adult is a person who is over 18 years old and who may be in need of community care services by reason of mental or other disability, age or illness and who may be unable to take care of him or her self against significant harm or exploitation.”¹

Vulnerable adults may be:

• Elderly and frail
• The subject to abuse in a domestic situation
• Asylum seekers or otherwise vulnerable due to dispossession
• Living in poverty
• Homeless

Vulnerable adults may have:

• A physical disability or sensory impairment
• A learning disability
• An incapacitating physical illness
• A mental illness
• Drug or alcohol problems
• Physical Frailty
• Challenging behavior

Risk factors include:

• When a person needs assistance to manage their continence
• Need for intimate personal assistance
• Living in the same household with a known abuser
• Family history of abuse
• Where an adult is dependent on others and others are dependent on them
• Inappropriate or dangerous physical or emotional environment, e.g., lack of personal space
• Existence of financial problems
• Differences in communication or a breakdown in communication
• A member of the household experiences emotional or social isolation
• The existence of or readily available assets

General indicators of abuse are:

• Unexplained reactions towards particular individuals or settings
• Frequent or regular visits to the general practitioner or the accident or emergency department
• Frequent or irrational refusal to accept investigations or treatments for routine difficulties
• Unexplained change in material circumstances
• Inconsistency of explanation regarding the area of possible concern
• Care worker always wishing to be present at interviews
• Anorexia or bulimia
• Panic attacks, withdrawal of verbal communication, regressive behavior
• Disturbed sleeping patterns
• Absconding or wandering
• Dislike of being touched or flinching upon being touched
• Self harm
• Obsessive or challenging behavior

Signs of physical abuse include:

• Bruising, particularly in well protected and covered areas
• Fractures
• Sprains or dislocations
• Lacerations
• Burns including friction burns and scalds
• Drowsiness, confusion due to over sedation
• Pressure sores
• Welt marks
• Symmetrical grip marks/bruising caused by fingertips
• Cowering and flinching
• Unexplained hair loss
• Significant weight loss

Signs of sexual abuse include:

• Repeated urinary infections
• Sexually transmitted diseases
• Incontinence/bed wetting
• Bruising, bleeding, soreness, cuts—particularly around breasts, anal, vaginal, or genital areas
• Pregnancy
• Depression, unexplained behavior changes
• Sexual dis-inhibition
• Deliberate self-harm, self-neglect, poor self-image, self-inflicted injuries
• Excessive masturbation
• Excessive washing
• Inappropriate dress
• Panic attacks, disturbed sleep patterns
• Overt sexual behavior or language
• Reluctance to be alone with an individual known to them
• Fear of staff offering help with undressing, bathing, etc.

Signs of psychological/emotional abuse include:

• Notable changes in behavior, either gradual or sudden anxiety, unease or silence
• Fear, withdrawal and inability to communicate when the alleged perpetrator is present
• Depression
• Deterioration in ability to exercise choice
• Irrational fears
• Onset of phobias
• Excessive deference to caregiver, care worker, or third party
• Over protective
• Violation of civil liberties

We need to look carefully at each situation and remember that the presence of one of more of these factors does not automatically imply abuse, but might increase the likelihood that abuse has occurred.

[1] Law Commission Report 231, 1995

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